Provider Demographics
NPI:1760095335
Name:YANG, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 N FARMERSVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93223-2306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1710 N FARMERSVILLE BLVD
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:CA
Practice Address - Zip Code:93223-2306
Practice Address - Country:US
Practice Address - Phone:559-321-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist